ANTENATAL CARE (ANC)

 It is systematic supervision (Examination & Advice) of a woman during pregnancy.

AIMS & OBJECTIVE

 Aims are :-
( 1 ) To screen the “high risk” cases.
( 2 ) To prevent or to detect & treat at the earliest any complication.
( 3 ) To ensure continued risk assessment & to provide preventive health care.
( 4 ) To educate mother about physiology of pregnancy & labor by demonstrations & diagrams, so that fear is removed
& Psychology is improved.
( 5 ) To discuss with the couple about place, time & mode of delivery & care of the new-born.
( 6 ) To motivate couple about need of family planning & also appropriate advice to couple seeking MTP.

 Objective is :- To ensure a normal pregnancy with delivery of a healthy baby from a healthy mother.

ANC COMPRISES OF :-
• History Taking
• Antenatal Examination (General & Obstetrical)
• Laboratory Investigations
• Advice given to Pregnant Woman
ANC VISITS
 Generally, check-up is done at interval of 4 weeks up to 28 weeks ; at interval of 2 weeks up to 36 weeks & Thereafter
weekly till delivery.
 Minimum 4 ANC visits are there :-
First visit :- Around 16 weeks
Second visit :- Between 24 & 28 weeks
Third visit :- At 32 weeks
Fourth visit :- At 36 weeks
PROCEDURE AT THE FIRST VISIT
 HISTORY TAKING :-
▪ Particulars of the Patient
▪ Chief complaints with Duration
▪ Past History
▪ Obstetrics History
▪ Menstrual History
▪ Family History
▪ Medical History
▪ History of Immunization
▪ Socio-economic History
▪ Contraceptive History
▪ History of Allergy

 EXAMINATION :-
▪ General Physical Examination :-
 Build :- Obese/average/thin.
 Height
 Weight :- Regular weight monitoring at each visit. 11 kg weight gain in entire pregnancy.
 Pallor :- Sites to be noted are Palpebral conjunctiva, Tongue & Nails.
 Pulse :- 60-90/min.
 Respiration rate :- 18-20 breaths/min.
 Blood Pressure :- Systolic BP :- >140 mm Hg & Diastolic BP :- >90 mm Hg.
 Urine :- For presence of Albumin.
 Pre-eclampsia :- Hypertension + Albuminuria
 Eclampsia :- Hypertension + Albuminuria + Convulsions.
 ▪ Systemic Examination :- Heart, Lungs, Liver & Spleen.
▪ Breasts Examination done.
▪ Obstetrical Examination :-
 Abdominal examination :- Measurement of Fundal height
− Fetal Heart Sound
− Fetal movements
− Multiple pregnancy
− Fetal Lie & Presentation
− Inspection of Abdominal scar

 INVESTIGATIONS :-
▪ Blood :- Hb, ABO, Rh grouping & Blood glucose are done.
- HBs Ag Test done.
▪ Urine :- Protein, Sugar & Pus cells.
▪ USG for Pregnancy profile.
PROCEDURE AT THE SUBSEQUENT VISITS
• Patient complaints
• General examination
• Gestational age to be calculated
• Identification of problem
• Fetal movement
• SFH (Symphysis Fundal Height) measurement
• Health education
• Prophylaxis & Treatment of Anemia
• Developing individualized Birth Plan
SECOND VISIT (24-28 WEEKS)
 SFH Measurement
 To detect Multiple pregnancy
THIRD VISIT (32 WEEK)
 Screen For :-
1. Pre-eclampsia
2. Multiple Pregnancy
3. Anemia
4. IUGR
FOURTH VISIT (36 WEEK)
 Identification Fetal Movement :-
1. Lie
2. Presentation
3. Position
4. Birth Plan
ANTENATAL ADVICE
 PRINCIPLES :-
1) To counsel women about importance of regular checkup.
2) To maintain or improve health status of woman.
3) To improve Psychology & to remove the fear of the unknown.

 DIET :-
▪ Increased calorie requirement about 300 kcal / day in entire pregnancy.
▪ Supplementary iron therapy :- It is needed for all pregnant mothers from 20th weeks onwards.
- It is given for large women, twin & those women who took ANC late in pregnancy.
- Anemic women should also take it.
 ANTENATAL HYGIENE :-
▪ Rest & Sleep :-
− Excessive & Strenuous work should be avoided in the first trimester & last 4 weeks.
− Patient should be in bed for about 10 hours (8 hrs. at night & 2 hrs. at noon), esp. in last 6 weeks.

▪ Bowel care :-
− Due to Constipation, regular bowel movement is done by regulation of diet taking plenty of fluids,
vegetables & milk.

▪ Bathing :- Patient should take daily bath.

▪ Dressing :-
− Patient should wear loose but comfortable garments.
− High heel shoes should be avoided.
− Belt should be avoided.

▪ Care of Breasts :- Wash the breast with clean tap water.

▪ Coitus :- It is not restricted during pregnancy. Women with increased risk of miscarriage should avoid it.

▪ Travel :- Travel by vehicles having jerks is avoided, especially in first trimester & last 6 weeks.

▪ Smoking & Alcohol :- It is avoided as it may affect Fetal well-being.

▪ Exercise :-
− Avoid lifting heavy things.
− Avoid long time standing.
− Avoid sitting with crossed legs.